Hemodynamic effects of intravenous nicardipine in severely pre‐eclamptic women with a hypertensive crisis

Cornette, J.; Buijs, Erik; Duvekot, Johannes J.; Herzog, Emilie M.; Roos‐Hesselink, Jolien W.; Rizopoulos, Dimitris; Meima, Marcel E; Steegers, Eric A.P.

doi:10.1002/uog.14836

Cited by 21 publications

(13 citation statements)

References 51 publications

(62 reference statements)

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“…As recently reviewed, few trials have evaluated hemodynamic‐guided antihypertensive therapy in pregnant women 7. Similar to the non‐pregnant literature, antihypertensive therapy based on cardiac output and total peripheral resistance may be an effective therapeutic strategy to improve maternal blood pressure control 23, 26, 27, 28, 29. Hemodynamic‐guided antihypertensive therapy for pregnant women presenting with any type of hypertension significantly reduced the rates of severe maternal hypertension from 18% to 3.5%, when compared with standard care 30.…”

Section: Discussionmentioning

confidence: 98%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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BackgroundHypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy.Methods and ResultsTwenty‐six normotensive pregnant women from a specialized Placenta Clinic at increased risk of developing de novo hypertension and 20 normotensive healthy pregnant controls were recruited at 22 to 26 weeks' gestation. Fourteen maternal clinical, hemodynamic, and placental characteristics were assessed in the second trimester and aggregated. Principal component analysis of this combined data set determined that 3 dimensions accounted for 56% of the cohort variability. The first dimension accounted for 31% of the cohort variability, with significant contributions from total peripheral resistance, endoglin, and cardiac output. The second dimension was predominantly influenced by body mass index and mean arterial pressure, while uric acid and myeloperoxidase mainly contributed to the third dimension. Unsupervised clustering identified 3 groups within this combined data set. Total peripheral resistance was the most significant distinguishing parameter between these groups (P<0.0001), followed by placental growth factor, endoglin, and cardiac output (P<0.0001). Using these 4 parameters, a receiver operating curve was constructed with an area under the curve of 0.975 (95% confidence interval 0.93–1) for the prediction of developing hypertension in pregnancy.ConclusionsConsolidated assessment of prognostic indicators in the second trimester of pregnancy may be useful to characterize and distinguish pathways by which women may develop hypertension in pregnancy. This approach could contribute to the development of pathway‐specific preventative and antihypertensive treatment strategies.

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Section: Discussionmentioning

confidence: 98%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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“…It is considered beneficial to screen pregnant women at higher risk of heart failure before echocardiography using biomarkers, such as brain natriuretic peptide (BNP)/NT-proBNP and troponin I. Elevated levels of both troponin I and NT-proBNP are seen in patients with heart failure caused by peripartum cardiomyopathy,9 10 and high-sensitivity troponin T retains prognostic value in patients with chronic heart failure 11–13. However, there have been few studies regarding the associations between biomarker levels and echocardiography findings in pregnancy 14–17…”

Section: Introductionmentioning

confidence: 99%

Morphofunctional cardiac changes in pregnant women: associations with biomarkers

Umazume

Yamada

et al. 2018

Open Heart

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ObjectiveThis longitudinal study was performed to determine changes in echocardiography parameters in association with various biomarker levels in pregnancy/postpartum.MethodsFifty-one healthy pregnant women underwent echocardiography with simultaneous determination of blood levels of five biomarkers at each of the first, second and third trimesters of pregnancy, immediately postpartum within 1 week after childbirth and approximately 1 month postpartum. Data on 255 echocardiography scans (five times per woman) and biomarkers were analysed.ResultsLeft ventricular end-diastolic dimension, left atrial (LA) volume index and left ventricular (LV) mass index increased with advancing gestation and reached the maximum immediately postpartum concomitant with the highest brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI) and creatine kinase MB levels. The inferior vena cava diameter was significantly reduced in the third trimester compared with that in the first trimester and the peak occurred immediately after childbirth. In 255 paired measurements, hs-TnI level was significantly positively correlated with LA volume index and LV mass index; BNP and NT-proBNP were significantly positively correlated with LA volume index and estimated glomerular filtration rate (eGFR) was significantly positively correlated with the average of early diastolic septal and lateral mitral annular velocity (e′).ConclusionsMaximal cardiac changes in morphology occurred postpartum within 1 week after childbirth, not during pregnancy. BNP/NT-proBNP, hs-TnI and eGFR reflected cardiac changes in pregnancy.

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“…Maternal CO is an important hemodynamic parameter that is subjected to substantial changes in pregnancy. TTE using pulsed‐wave Doppler ultrasound in the LVOT position is commonly used for CO measurement. Nevertheless, our systematic review revealed only three validation studies, including our own prospective study, of limited size, comparing TTE with the clinical gold standard.…”

Section: Discussionmentioning

confidence: 97%

“…Pregnancy imposes a substantial challenge on the maternal cardiovascular system. Complications such as pre‐eclampsia, cardiac disease, sepsis, hemorrhage and pulmonary embolism, which account for the majority of severe maternal morbidity and mortality, are characterized by profound hemodynamic disturbances. Maternal pulse rate and blood pressure are easily obtained and are often used alone as indirect surrogates of maternal cardiovascular function.…”

Section: Introductionmentioning

confidence: 99%

“…Maternal pulse rate and blood pressure are easily obtained and are often used alone as indirect surrogates of maternal cardiovascular function. Nevertheless, knowledge about cardiac output (CO) can be important when managing hemodynamically compromised pregnant women or studying (patho)physiological conditions in pregnancy. Thermodilution by pulmonary artery catheterization (PAC), using a Swan–Ganz catheter, is considered the clinical gold standard for CO measurement.…”

Section: Introductionmentioning

confidence: 99%

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Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review

Cornette

Laker

Jeffery

et al. 2016

Ultrasound in Obstet & Gyne

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Hemodynamic effects of intravenous nicardipine in severely pre‐eclamptic women with a hypertensive crisis

Abstract: Objective Nicardipine permits rapid control of blood pressure in women with severe pre-eclampsia (PE)

Cited by 21 publications

References 51 publications

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

Morphofunctional cardiac changes in pregnant women: associations with biomarkers

Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review

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